How We Are Humanizing Medical Education

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How We Are Humanizing Medical Education

• Peggy Wallace, Ph.D.
• www.coachingsps.com

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Humanizing Medical Education

• when physicians are more humanistic in their
  interactions with patients, their patients have
  more positive health outcomes.

Geoffrey Williams Annals of Internal Medicine,
1998
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Humanizing Medical Education

• when medical educators are more humanistic in
  their training of students, the students become
  more humanistic in their care of patients.

Geoffrey Williams Annals of Internal Medicine,
1998
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SP Disciplines

• Education
• Evaluation
• Experiential Learning
• Performance Assessment
• Clinical Skills

• Medical Knowledge
• Psychology
• Administration
• Acting
• Directing

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Coaching

• Active Learning
• Performance Assessment
• Creating a Portrayal
• Accomplishments

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Active Learning

• Communication Skills
• Feedback

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Active Learning

• Communication Skills
• Most used clinical skill
• 150,000 encounters in a physicians lifetime
• Relationship
• Happens as a process of experience
• Awareness
• What is true for this student that hes
  learning about himself in relationship to
  this patient that this SP is portraying?

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The Healers Art

• Kindness
• Vulnerability
• Honesty
• Generosity
• Holiness
• Humanness

• Tenderness
• Inner peace
• Heart
• Justice
• Wonder
• Curiosity

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Active Learning

• Value self-awareness more than
• Self-aggrandizement
• Self-diminishment
• Self-criticism
• Denial

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Self-Awareness

• The piece that I feel more and more passionate
  about is that self-awareness is not a virtue in
  and of itself -
• rather, it is a part of becoming a mindful
  practitioner, which is ultimately in the service
  of both compassion and competence.

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Self-Awareness

• Mindfulness is a commitment to knowing oneself
  (from ones ability to tie a suture to the
  personal feelings on losing a friend). Its a
  commitment to knowing oneself in every moment
  and to make every moment count.

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Self-Awareness

• But most important is that you be you.
• Content may be less important than presence.
• Ron Epstein, MD
• 1999

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Active Learning

• Experience self-awareness
• Practice communication skills

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Performance Assessment

• Accuracy of the data SPs are recording on
  students performances
• Authenticity and accuracy of SPs
  performances

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Performance Assessment

• Selection of SPs
• Quality of coaching
• Clear checklist items
• Coaches care about accuracy
• Diligent in training
• Rigorous in monitoring

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Performance Assessment

• If the data that the psychometrician receives
  is flawed, no psychometric technique can overcome
  the errors in the data.

Emil Petrusa, PhD 2006
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Performance Assessment

• SPs provide the fundamental material that is the
  foundation for interpretation of the data.

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Performance Assessment

• If that foundation is not solid, everything
  built on it is flawed.

Emil Petrusa, PhD 2006
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Performance Assessment

• Standardized patients have become the surrogates
  for direct faculty observation.

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Performance Assessment

• Data from SP-based examinations, in and of
  themselves, do not indicate the accuracy of the
  SPs recall or the correctness of the SPs
  judgments.

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Performance Assessment

• SP Educators are solely accountable for the
  baseline quality assurance of the data collected
  during clinical skills assessments.

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Creating a Portrayal

• SP Performance
• Factual accuracy
• Authenticity of portrayal

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Language of SP Coaching

• Play the part
• Pose as
• Train
• Direct
• Auditions
• Call backs
• Cast

• Perform
• Improvising
• Scenario
• Portray
• Role
• Character
• Backstory

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Creating a Portrayal

• Training materials must include everything that
  the SP needs to be able to portray the patient
  accurately and authentically.

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Creating a Portrayal

• Remove the meaning from patients stories and
  they become unrecognizable - sanitized, dull,
  dry, as if they were being recited by a computer.
  
• This is why meaning accounts for the crucial
  difference between disease and illness.

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Creating a Portrayal

• Illness is something that happens to persons,
  while disease is what happens to the organs of
  the body.
• Illness is disease plus meaning.
• Larry Dossey, MD
• Meaning and Medicine

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Creating a Portrayal

• Meaning creates a context
• Relationship to the doctor
• Limited options and control in the
  clinical setting

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Creating a Portrayal

• SPs need to understand
• Patients needs
• Patients expectations
• Patients fears
• SPs own psychology

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Creating a Portrayal

• Acting is not about being someone different.
  Its finding the similarity in what is
  apparently different, then finding myself in
  there.
• Meryl Streep

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Creating a Portrayal

• Living truthfully under imaginary
  circumstances
• Sanford Meisner
• 1987

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Creating a Portrayal

• The closer our SPs come to realistically
  portraying the patients, the closer the
  simulation is to reality.
• The closer the simulation is to reality the more
  likely it is that the student is going to respond
  in that interaction as she would if she were
  working with a real patient.

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SP Accomplishments

• Remember facts
• Deliver facts
• Believably portray emotional and psychological
  aspects
• Observe students behaviors

• Recall students behaviors
• Accurately record the behaviors
• Give beneficial feedback

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SP Coach Accomplishments

• Select SPs
• Interpret case authors vision
• Coach factual accuracy
• Coach believable portrayals

• Ensure item understanding
• Monitor portrayals and checklist accuracy
• Give feedback on all aspects

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